Substance use disorders (SUD) often co-occur with criminality, including violence, arrests, and incarceration\(^{[1; 2; 3]}\). People with polysubstance use (PSU) are considered a high-risk population, as they are associated with mortality, relapse, and contact with the criminal justice system (CJS)\(^{[4; 5; 6]}\). Although completing SUD treatment is linked with better outcomes, including preventing contact with CJS, the role of treatment completion in the link between PSU and contact with CJS is unclear\(^{[7; 8]}\). Studies have found mixed evidence regarding the association between PSU and treatment completion rates\(^{[9; 10; 11; 12]}\). Thus, it is crucial to determine the role of treatment completion in order to improve outcomes in people with PSU. However, analyzing the role of treatment outcomes in people with PSU is challenging, as there is limited research on this population in Latin America, and high-risk populations have often been overlooked\(^{[13; 14; 15]}\). The study contributes to a growing literature on the importance of addressing longitudinal dynamics in specific profiles of SUD patients. Studying the link between PSU, treatment completion, and criminality is crucial for evidence-based strategies to address SUD-related issues. Effective interventions and tailored approaches for people with PSU can mitigate societal and individual harms stemming from SUDs and criminal behavior.
Objectives: To estimate the mediating effects of completing SUD treatment on the relationship between PSU at admission and contact with CJS among adult patients admitted to SUD treatment programs in Chile during 2010-2019. Specific: (1) To describe the prevalence of PSU, treatment completion, and contact with CJS in the sample, (2) to compare the risk of contact with CJS between people with poly and single-substance use, and (3) to estimate the proportion of the effect of PSU and treatment outcome on the contact with CJS.
Design: a retrospective cohort based on the administrative data’s record linkage. Data: Chilean SUTs programs and Prosecutor’s Office through a deterministic linkage process. Ethics: We are in the process of an amendment to an existing ethical approval from a study using the same data.
Exposure: baseline PSU (using more than one main substance among alcohol and illicit drugs at admission to SUD treatment, whether sequential or concurrent); Mediator: SUD treatment outcome (complete vs. dropout or spelled by misconduct); Outcome: contact with CJS (committing an offense that led to a condemnatory sentence).
Figure 1: Covariate balance
Figure 2: Multistate scheme
We calculated the Aalen-Johansen estimator for transition probabilities at 6 months, 1 & 3 years using multistate in Stata\(^{[17]}\). Secondary analyses will focus on mediating effects of treatment outcome and using a time-to-first-event approach\(^{[18; 19; 20]}\). Markdowns & codes are available on https://fondecytacc.github.io/nDP/.
| Transition | Time | PSU | No PSU |
|---|---|---|---|
| From admission to contact with CJS | 6_mths | 2.2 (2.1,2.3) | 1.8 (1.7,1.9) |
| From admission to contact with CJS | 1_yr | 7.9 (7.6,8.1) | 6.6 (6.4,6.8) |
| From admission to contact with CJS | 3_yrs | 24.4 (24.0,24.7) | 20.7 (20.3,21.1) |
| From admission to contact with CJS | 5_yrs | 33.3 (32.8,33.7) | 29.5 (29.0,30.0) |
| From admission to tr.completion | 6_mths | 3.1 (2.9,3.2) | 4.0 (3.9,4.2) |
| From admission to tr.completion | 1_yr | 14.6 (14.3,14.8) | 17.6 (17.3,18.0) |
| From admission to tr.completion | 3_yrs | 23.6 (23.2,23.9) | 27.0 (26.6,27.4) |
| From admission to tr.completion | 5_yrs | 21.4 (21.0,21.8) | 24.9 (24.4,25.3) |
| From tr.completion to contact with CJS | 6_mths | 3.0 (2.0,4.0) | 2.4 (1.3,3.4) |
| From tr.completion to contact with CJS | 1_yr | 8.7 (7.5,9.8) | 5.9 (4.8,7.0) |
| From tr.completion to contact with CJS | 3_yrs | 21.1 (20.0,22.3) | 16.2 (15.1,17.3) |
| From tr.completion to contact with CJS | 5_yrs | 28.6 (27.4,29.8) | 23.0 (21.8,24.2) |
People with PSU have higher probabilities of contact with the CJS, both after admission and after treatment completion, vs. without PSU. Also, people with PSU are less likely to complete treatment vs. no PSU. Treatment completers had lower probabilities of contact with the CJS vs. non-completers after 3 years since admission.
Treatment completion can reduce the risk of criminal justice involvement, which is evident at 3-year mark when most users have finished treatment. Further analysis is needed. People with PSU may need enhanced treatment to complete treatments and avoid contact with the CJS.
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